Section 1561 of The Patient Protection and Affordable Care Act (Healthcare Reform) contains a section on healthcare IT standards for enrollment. The ultimate goal here is extremely valuable to constituents, to use application integration technologies to create a constituent-facing view of government IT systems that is less siloed than the systems themselves. This is important because the IT systems themselves are spread across different jurisdictions, different departments, enabled by different laws and overseen in different legislative committees. Desiloing the underlying systems is a long-term proposition. Front-ending separately developed applications offers the potential to begin showing results in as little as a year and being substantially rolled out in a few years.

Not later than 180 days after the date of enactment of this title, the Secretary, in consultation with [two federal advisory committees,] the HIT Policy Committee and the HIT Standards Committee, shall develop interoperable and secure standards and protocols that facilitate enrollment of individuals in Federal and State health and human services programs…

Enrolling in social assistance programs is currently a nightmare. Someone who is newly unemployed faces a monumental burden of paperwork signing up for unemployment benefits, Supplemental Nutrition Assistance Program (SNAP – nee food stamps), Medicaid and other programs. They must fill out a hundred or more pages of application forms, most of which are redundant from one form to the next. While many programs now allow Web-based application, each application goes to a different siloed government system.

Siloed governmental systems place a burden on all constituents, whether they are running a business, applying for student loans or pursuing a bow-hunting license. For example, applying for a student loan requires a filling in great deal of data that already is reposed on servers of the Internal Revenue Service.

There is a further burden of cross-checking information among government programs that delays services to constituents and increases the enrollment cost of government.

Process
The federal advisory committee portion of the work will be chaired by US CTO Aneesh Chopra and Sam Karp of the California Healthcare Foundation (CHCF). The CHCF is a highly endowed non-profit that directs its resources at improving healthcare for the broad population. Sam has assisted the CHCF in pursuing common enrollment for several years now. Aneesh has demonstrated a clear direction towards finding ways that industry can work to the betterment of governance. His vision is to find ways to enable innovation at the interfaces among government agencies and between such agencies and constituents and commercial providers of IT services.

Aggressive Deadlines
The 111th Congress has characteristically put very aggressive deadlines on Health IT goals and Section 1561 is no exception. The committee must complete its work in substantially less than the four months that remain so that the Office of the National Coordinator can complete the recommendation and it can go through internal coordination before being presented to Congress.

Having helped a bit with the work under the ARRA I have concluded that aggressive deadlines are good. They shift the discussion from “whether” or “how best” to do something to “how to do it well enough in a specific time frame.” Until this particular “shift happens” the wheels tend to spin forever.

However, there is a balance. When the “shift” happens the “short-shrift” happens too. Issues are not explored to a level that provide a basis for action. In the case of Section 1561 this could take the form of a committee publishing recommendations that do not form a basis for a solid recommendation from the Secretary, much less an implementation program that benefits constituents in a reasonable time. (What’s a reasonable time? The 2012 elections seem awfully close.)

In my next blog entry I will suggest a particular point of view that may represent the balance point between “good shift” and “short shrift.”

Wes Rishel
VP Distinguished Analyst12 years at Gartner 45 years IT industry

Wes Rishel is a vice president and distinguished analyst in Gartner's healthcare provider research practice. He covers electronic medical records, interoperability, health information exchanges and the underlying technologies of healthcare IT, including application integration and standards. Read Full Bio

Thoughts on Can IT Help Government Be Less Bureaucratic?

As with HIPAA, this is going to be a huge consulting franchise, helping states reconfigure their Medicaid info systems.
Remember they have a negative incentive to increase enrollment because it increases their outlays.

Not only are states going to have to completely reconfigure their IT systems (eligibility standards are mandated to change as well) , but then they are going to have to re-enroll everyone to assure the feds they comply with the new standards. THEN, they have to go out and grow their enrollment by about 30%. Lots of providers wonder if many states will have the organizational capacity to pull it off.

Jeff, the states have quotas and variable eligibility rules that they use to moderate their expenditures on social services. They also have some positive incentives for this program. Many of the recipients of social services programs are active voters, particularly when unemployment is a factor and the same techniques can be used for constituent services that are not associated with social services.

I agree that the cost is not trivial and progress may be gradual, but in my examination so far it appears that the problem is worthy and the techniques of Web-service-based application integration are well suited to it.

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